Journal of Gerontological Nursing

CNE Article 

Associations of Social Support and Self-Efficacy With Quality of Life in Older Adults With Diabetes

Pamela G. Bowen, PhD, FNP-BC; Olivio J. Clay, PhD; Loretta T. Lee, PhD, FNP-BC; Jason Vice, OTS; Fernando Ovalle, MD; Michael Crowe, PhD

Abstract

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1.2 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded once you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf. To obtain contact hours you must: Read the article, “Associations of Social Support and Self-Efficacy With Quality of Life in Older Adults With Diabetes” found on pages 21–29, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz.

Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study.

Go to the Villanova website listed above to register for contact hour credit. You will be asked to provide your name; contact information; and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated.

This activity is valid for continuing education credit until November 30, 2018.

Contact Hours

This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated.

Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

Activity Objectives
  • Describe the relationship among social support, self-efficacy, and quality of life in older adults with diabetes.
    State the authors' suggestion for future research based on the study outcomes.

  • Disclosure Statement

    Neither the planners nor the authors have any conflicts of interest to disclose.

    Older adults are disproportionately affected by diabetes, which is associated with increased prevalence of cardiovascular disease, decreased quality of life (QOL), and increased health care costs. The purpose of the current study was to assess the relationships between social support, self-efficacy, and QOL in a sample of 187 older African American and Caucasian individuals with diabetes. Greater satisfaction with social support related to diabetes (but not the amount of support received) was significantly correlated with QOL. In addition, individuals with higher self-efficacy in managing diabetes had better QOL. In a covariate-adjusted regression model, self-efficacy remained a significant predictor of QOL. Findings suggest the potential importance of incorporating the self-efficacy concept within diabetes management and treatment to empower older adults living with diabetes to adhere to care. Further research is needed to determine whether improving self-efficacy among vulnerable older adult populations may positively influence QOL. [Journal of Gerontological Nursing, 41(12), 21–29.]

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    Abstract

    How to Obtain Contact Hours by Reading This Article
    Instructions

    1.2 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded once you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf. To obtain contact hours you must: Read the article, “Associations of Social Support and Self-Efficacy With Quality of Life in Older Adults With Diabetes” found on pages 21–29, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz.

    Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study.

    Go to the Villanova website listed above to register for contact hour credit. You will be asked to provide your name; contact information; and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated.

    This activity is valid for continuing education credit until November 30, 2018.

    Contact Hours

    This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated.

    Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

    Activity Objectives
  • Describe the relationship among social support, self-efficacy, and quality of life in older adults with diabetes.
    State the authors' suggestion for future research based on the study outcomes.

  • Disclosure Statement

    Neither the planners nor the authors have any conflicts of interest to disclose.

    Older adults are disproportionately affected by diabetes, which is associated with increased prevalence of cardiovascular disease, decreased quality of life (QOL), and increased health care costs. The purpose of the current study was to assess the relationships between social support, self-efficacy, and QOL in a sample of 187 older African American and Caucasian individuals with diabetes. Greater satisfaction with social support related to diabetes (but not the amount of support received) was significantly correlated with QOL. In addition, individuals with higher self-efficacy in managing diabetes had better QOL. In a covariate-adjusted regression model, self-efficacy remained a significant predictor of QOL. Findings suggest the potential importance of incorporating the self-efficacy concept within diabetes management and treatment to empower older adults living with diabetes to adhere to care. Further research is needed to determine whether improving self-efficacy among vulnerable older adult populations may positively influence QOL. [Journal of Gerontological Nursing, 41(12), 21–29.]

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    In 2010, approximately 10.9 million (26.9%) older adults had diabetes; by 2050, this number is projected to increase to 26.7 million (55%) (Caspersen, Thomas, Boseman, Beckles, & Albright, 2012; Centers for Disease Control and Prevention [CDC], 2011). Diabetes is a chronic metabolic condition that requires a multifaceted approach to manage the costly burden that accompanies this disease. In addition, diabetes is a significant health care issue that cost the United States approximately $245 billion in 2012, which was a 41% increase from 5 years earlier (American Diabetes Association, 2013). Diabetes in older adults is a growing, public health problem. Increased life expectancy along with the growing population will likely increase the health care burden of managing chronic conditions, such as diabetes, among older adults (U.S. Department of Health & Human Services [USDHHS], 2010).

    Diabetes is associated with several comorbidities (e.g., diabetic retinopathy, neuropathy, nephropathy), and an overwhelming majority of research studies report a strong association between diabetes and cardiovascular disease (i.e., heart disease and stroke). Adults with diabetes are up to four times more likely to have heart disease or a stroke compared to individuals without diabetes; in turn, heart disease and stroke are the top causes of death in individuals with diabetes (CDC, 2011) and older adults with diabetes show overall increased mortality rates. The combination of diabetes and other comorbid conditions would presumably heighten the medical complexity for older adults and make care for them particularly challenging. More importantly, the heterogeneity of chronic diseases associated with diabetes can translate to decreased life expectancy and quality of life (QOL) for older adults.

    QOL is an intricate, multidimensional, subjective appraisal of an individual's existing life circumstances and satisfaction as it relates to his/her well-being, culture, values, and psychosocial and spiritual dimensions (Haas, 1999; Hardin, 2010). Moreover, QOL is a nonspecific label that encompasses contentment with the physical and psychosocial elements of an individual's health, which may be especially important among older adults with diabetes. One of the Healthy People 2020 goals is to improve health-related QOL as evidenced by more individuals self-reporting better physical and mental health (USDHHS, 2013). To ensure older adults have the chance to achieve and maintain a good QOL, the health care community must understand the role that social support and self-efficacy play in individuals' well-being. For example, Beverly et al. (2013) found that older adults positively benefited from diabetes behavioral interventions that included psychosocial factors, such as QOL, diabetes distress, and self-efficacy. Using these types of strategies may help improve QOL perceptions among older adults.

    Quality of Life and Social Support

    Social support encompasses the self-appraisal of real or perceived social networks of family, friends, and organizations, which provide emotional, financial, or personal assistance when needed (Debnam, Holt, Clark, Roth, & Southward, 2012; Eaker, 2005; Gallant, 2003; Tang, Brown, Funnell, & Anderson, 2008). In addition, social support is an essential component for the adoption and maintenance of self-care measures in diabetes management (Coffman, 2008; Strom & Egede, 2012); therefore, it is essential to examine the interplay between social support, physical health, and QOL (Uchino, 2009). Older adults who have or perceive themselves to have a good social network are more likely to show better health outcomes (Uchino, 2009), which is particularly important in predicting the adoption of healthy behaviors to manage chronic diseases, such as diabetes (Tang et al., 2008). Because social support is a multifaceted concept that is essential for disease management, it is important to know how satisfied older adults are with the type and amount of social support they receive.

    Tang et al. (2008) investigated four social support variables among 89 African American adults diagnosed with diabetes, which included the amount and satisfaction of diabetes-related support received as well as positive and negative support behaviors. The authors found that diabetes support satisfaction was associated with improved QOL and glucose monitoring; positive support predicted adhering to a healthy diet and regular physical activity, whereas negative support predicted noncompliance with medications. These findings suggest diabetes-related social support has an important role in improving QOL and self-management behaviors among individuals with diabetes.

    Similarly, Strom and Egede (2012) examined information on clinical outcomes, behavioral modification, psychological factors, and social support preferences and concluded that increased levels of social support will likely yield improved health-related decision making, adoption of healthy lifestyle behaviors to manage chronic diseases, and more positive health outcomes. Regarding satisfaction with social support for disease management, the amount of satisfaction one perceives depends on the relationship between the giver and receiver of the support provided (Nicklett, Heisler, Spencer, & Rosland, 2013). Results suggest that the more support satisfaction an individual with diabetes experiences, the more likely this support will protect against diabetes burden (Baek, Tanenbaum, & Gonzalez, 2014).

    Self-Efficacy Among Older Adults with Diabetes

    Achieving good glycemic control for older adults living with diabetes requires successful daily management of blood glucose and appropriate levels of self-efficacy to manage the disease (Beckerle & Lavin, 2013). Higher levels of self-efficacy among older adults with diabetes are associated with self-motivation, self-empowerment, and self-confidence about their abilities to influence disease outcomes. Previous study findings have reported a positive association between self-efficacy and diabetes self-care management (Naccashian, 2014; Song, Ahn, & Oh, 2013), and between self-efficacy and hemoglobin A1C levels (Richardson, Derouin, Vorderstrasse, Hipkens, & Thompson, 2014). Richardson et al. (2014) examined self-efficacy screening scores before and after implementation of a self-efficacy intervention to investigate pre and post hemoglobin A1C levels in adults (mean age = 58 years) with diabetes; there were significant improvements in patients' hemoglobin A1C levels and self-efficacy scores after the intervention. In another study, Huffman et al. (2010) examined the association of diabetes, self-efficacy, and physical activity among older adults (average age = 78 years) with arthritis. Using validated measures of self-efficacy (McAuley, 1993), participant data were dichotomized as having high or low self-efficacy. Findings revealed that among older adults with diabetes and arthritis, lower self-efficacy was associated with limited physical activity (e.g., endurance training); higher levels of self-efficacy were reported in older adults with arthritis alone.

    Several studies have examined the relationship between social support (Condrasky, Baruth, Wilcox, & Carter, 2013; Shaya et al., 2013; Utz et al., 2008; Watkins, Quinn, Ruggiero, Quinn, & Choi, 2013) and self-efficacy (Al Sayah, Majumdar, Egede, & Johnson, 2015; Kim, Shim, Ford, & Baker, 2015; Peek et al., 2012; Peyrot et al., 2014; Steinhardt, Mamerow, Brown, & Jolly, 2009) and diabetes-related outcomes. However, few studies have examined the relationship between social support and self-efficacy among African American individuals with diabetes (Heisler & Piette, 2005; Hunt, Grant, & Pritchard, 2012; Klug, Toobert, & Fogerty, 2008; Lorig, Ritter, Villa, & Armas, 2009). For example, Klug et al. (2008) found a positive association between social support and self-efficacy among individuals with diabetes; however, only 1% of the sample were African American individuals. Similarly, Lorig et al. (2009) reported a positive link between social support and self-efficacy in a sample that was 70% non-Hispanic White individuals with diabetes; there was no indication of the number of African American participants. However, 60% of participants with diabetes in Hunt et al.'s (2012) study were African American and a positive association between social support and self-efficacy was found. More research examining the importance of social support and self-efficacy for diabetes-related outcomes in African American individuals (Chlebowy & Garvin, 2006; Komar-Samardzija, Braun, Keithley, & Quinn, 2012) is needed to aid in the development of interventions targeted to improve overall QOL across diverse populations.

    The purpose of the current study was to examine associations between social support, self-efficacy, and QOL variables in a sample of older adults with diabetes. Based on previous literature, it was hypothesized that higher levels of (a) social support and (b) self-efficacy would be associated with better QOL (Bond, Burr, Wolf, & Feldt, 2010; Shen, Edwards, Courtney, McDowell, & Wu, 2012). In a prior study, researchers examined the relationship between social support, self-efficacy, and outcome expectations (i.e., glucose control and self-care) among 27 African American and 64 White adults with type 2 diabetes (Chlebowy & Garvin, 2006). Results suggested that African American individuals were more likely than White individuals to experience diabetes complications or distress when social support satisfaction was limited and the impact of self-efficacy was unclear (Chlebowy & Garvin, 2006). The current investigation adds to the literature by informing health care providers of potential factors that may increase diabetes self-efficacy among this population.

    Method

    Procedures

    Data from the University of Alabama at Birmingham (UAB) Diabetes and Aging Study of Health (DASH) were analyzed for the current study. The overall aim of the UAB DASH was to examine racial differences in older African American and Caucasian individuals with diabetes (Jones, Clay, Ovalle, Cherrington, & Crowe, 2015). Participants included community-dwelling older adults from Birmingham, Alabama and surrounding areas as well as patients from a diabetes clinic at UAB. All participants were 65 and older and had diabetes identified either by self-report or physician diagnosis. Community-dwelling participants were recruited from a commercially available list of older adults in the Birmingham metropolitan area that is maintained by the UAB Roybal Center for Translational Research on Aging and Mobility. Clinic participants were recruited from patients of one physician at the UAB Diabetes & Endocrinology Clinic. All participants were contacted via a mailed letter followed by telephone contact. African American individuals were oversampled because the overarching goal was to examine racial disparities in mental health, cognitive function, and mobility outcomes in older adults with diabetes.

    Participants provided verbal informed consent and completed telephone interviews focused on diabetes-specific measures of health and psychosocial factors as well as performance-based cognitive testing. A total of 247 individuals (i.e., 72% community-dwelling and 28% clinic patients) were enrolled at baseline. Ten individuals from the UAB DASH identified as racial categories other than African American and Caucasian. Participants were assigned identification numbers and all identifying data were stored in locked file cabinets in locked offices in a separate building from storage of other data. All electronic data were stored on a password-protected server. The UAB Institutional Review Board reviewed and approved the study. Data from a 1-year follow-up telephone interview were used because QOL data were not collected at baseline. A sample of 187 (79%) of a possible 237 African American and Caucasian participants were retained at the 1-year assessment and provided complete data on the variables of interest.

    Demographics

    Age and education were reported in years. Race was coded as African American = 1 and Caucasian = 0. Gender was coded as female = 1 and male = 0.

    Social Support

    Amount of social support was assessed by asking participants, “How much support do you get dealing with your diabetes?” Response options ranged from 1 = no support to 5 = a great deal of support. Satisfaction with social support was assessed by asking participants, “How satisfied are you with the support you get for dealing with your diabetes?” Response options ranged from 1 = not at all satisfied to 5 = extremely satisfied. Higher scores reflect more support. These diabetes-specific support questions have been used previously (Tang et al., 2008). Tang et al. (2008) found that greater satisfaction with support was significantly associated with better diabetes-specific QOL and blood glucose monitoring. It is notable that this single-item satisfaction question was more highly related to QOL and glucose monitoring than support measures from the widely used 16-item Diabetes Family Behavior Checklist (Glasgow & Toobert, 1988).

    Quality of Life

    QOL was assessed using the EQ-5D, a standardized measure that has been widely applied to measure the impact of diabetes on QOL (Janssen, Lubetkin, Sekhobo, & Pickard, 2011). This 5-item measure is a summary score of an individual's health-related QOL in five domains (i.e., mobility, self-care, usual activities, pain/discomfort, and anxiety/depression). It has a possible range of 5 to 15; the current authors reverse-scored this measure so higher scores indicated better QOL. Internal consistency assessed by Cronbach's alpha for the scale was 0.72 within the current sample of older adults with diabetes.

    Diabetes Self-Efficacy

    The Perceived Diabetes Self-Management Scale (PDSMS; Wallston, Rothman, & Cherrington, 2007) was used to measure self-efficacy. There are eight items for the PDSMS and responses range from 1 = strongly disagree to 5 = strongly agree. Four items are reverse scored before summing to obtain scores that can range from 8 to 40, where higher scores indicate more confidence in diabetes management. Cronbach's alpha was 0.86 in the current sample, which was slightly higher than the previously reported internal consistency (Wallston et al., 2007).

    Analyses

    All analyses were conducted using SAS version 9.1.3. Frequencies and means were computed to examine sample descriptive statistics. Pearson's product–moment correlations were computed to examine bivariate associations between study variables. A multiple linear regression model was used to assess the covariate-adjusted associations between variables of interest and QOL.

    Results

    Participant Characteristics

    Descriptive statistics of the sample are presented in Table 1. There were 187 individuals who completed the 1-year telephone assessment and provided complete data for variables of interest. Approximately one half of participants were African American and approximately one half were female. Mean age of participants was approximately 75 years. The average QOL score as assessed by the EQ-5D was 12.93 (SD = 1.70). Amount of social support had a mean score of 3.54 (SD = 1.57) and the mean for satisfaction with social support was 4.41 (SD = 0.93). The average self-efficacy score was approximately 32. This was also the score that occurred most frequently within the sample (25% of participants scored 32 of 40 on the PDSMS).

    Descriptive Statistics (N = 187)

    Table 1:

    Descriptive Statistics (N = 187)

    Bivariate Correlations

    Associations between study variables are listed in Table 2. Female gender was associated with worse QOL (p < 0.05). Higher levels of education, greater satisfaction with social support, and greater self-efficacy were all related to better QOL (p < 0.05). The largest correlation was observed between QOL and self-efficacy (r = 0.416, p < 0.0001). QOL was not significantly associated with age, race, or amount of social support. There were moderate associations between satisfaction with and amount of social support (r = 0.371, p < 0.0001), as well as between satisfaction with social support and self-efficacy (r = 0.413, p < 0.0001).

    Correlation Matrix of Study Variables

    Table 2:

    Correlation Matrix of Study Variables

    Covariate-Adjusted Model Predicting Quality of Life

    Results from the multiple linear regression model predicting QOL scores are presented in Table 3. Due to the moderate association between the social support measures and lack of a significant association between amount of support and QOL, amount of support was not included in the regression model to reduce multicollinearity. All demographic measures were retained for the covariate-adjusted model; therefore, age, gender, education, race, satisfaction with social support, and self-efficacy were examined as predictors of QOL. The only variable that had a significant covariate-adjusted relationship with QOL score was self-efficacy (B = 0.376, p < 0.0001). Again, individuals with more self-efficacy managing their diabetes had better QOL.

    Covariate-Adjusted Relationships Between Variables of Interest and Quality of Life

    Table 3:

    Covariate-Adjusted Relationships Between Variables of Interest and Quality of Life

    Discussion

    Relationships between social support, self-efficacy, and QOL were examined in a sample of older adults. Specifically, the current study offers insights on how potentially modifiable factors are associated with QOL in older adults with diabetes. Unadjusted results revealed the strongest correlations between QOL and diabetes-specific social support and self-efficacy measures, although demographic factors (e.g., female gender, less education) were associated with lower QOL.

    Consistent with the first hypothesis, higher levels of satisfaction with diabetes-related social support were associated with better QOL. This finding is consistent with prior research, which indicates the positive role social support plays in managing chronic diseases, such as diabetes (Coffman, 2008; Tang et al., 2008; Thoits, 1995, 2011). Although satisfaction with and amount of social support an individual received were significantly and positively related to one another, being satisfied with diabetes-related social support was more important than amount of social support received in terms of QOL. These findings are generally consistent with existing studies that suggest better social support may positively influence disease management burden and QOL (Gallant, 2003; Gallant, Spitze, & Prohaska, 2007; Nicklett et al., 2013; Tang et al., 2008; Wang & Fenske, 1996).

    In relation to the second hypothesis, the current study supports a relationship between QOL and self-efficacy. These findings propose that individuals with higher self-efficacy managing their diabetes had better QOL and findings are consistent with prior research on the potential influence of self-efficacy on QOL (Jahanlou & Alishan Karami, 2011; Song et al., 2013). Because the measure of self-efficacy involves the perception of one's ability to effectively manage diabetes, strategies specifically designed to improve confidence in managing diabetes may be useful for improving QOL in this population. Consistent with previous research, incorporating the concept of self-efficacy when instructing older adults about diabetes care and management could increase the probability of this group adhering to treatment and having a higher QOL perception (Hurley & Shea, 1992; Liu, 2012; Mishali, Omer, & Heymann, 2011).

    Limitations

    Given that the current results are based on data exclusively from older adults from one Southern state, this limits generalizability to other regions, minority groups, and individuals younger than 65. The current study also relied on self-reported data to assess perceptions of received amounts of social support, which is subject to recall bias. Some individuals may want to present themselves in the best manner possible. Therefore, overreporting satisfaction and QOL may be an issue (Polit & Beck, 2008). Causal inferences cannot be drawn for associations with QOL because the analysis relied on cross-sectional, observational data.

    Clinical Implications

    Findings from the current study can be used by the health care community to help identify older adults with diabetes who may be at-risk for poor QOL. For example, health care professionals may screen older adults with diabetes for low self-confidence related to managing their condition. In addition, making sure older adults with diabetes receive adequate social support may lead to improved QOL for this population, although further experimental research is needed.

    Due to the high prevalence of diabetes among older adults and the substantial economic burden on patients and society, it is imperative that health care providers, along with policymakers, develop and implement strategies targeted to improve self-efficacy and social support that could potentially lead to improvements in QOL. For example, Beverly et al. (2013) investigated whether adults ages 60 to 75, compared to their younger counterparts, would benefit more from a group diabetes education class versus individual classes. They found that older adults with diabetes who participated in group diabetes self-management interventions achieved better psychosocial (e.g., QOL, distress, self-efficacy, coping) outcomes and glycemic control (Beverly et al., 2013). The group format allowed participants to react and be stimulated by others' viewpoints; thus, using this method may increase self-efficacy and social support (Carey & Forsyth, 2015). Therefore, health care providers and policymakers may increase use of group intervention strategies to increase self-efficacy and social support among older adults with diabetes. In another study, Coffman (2008) evaluated relationships between depression, social support, and self-efficacy among a sample of 115 older Hispanic adults with self-reported type 2 diabetes and found that the majority of participants needed support in the form of transportation; family was the major source of support (46.4%), followed by government-sponsored social programs (28%) and medical professionals (17.6%). Interestingly, a negative but significant relationship between support and self-efficacy was identified, which indicated that the more support an individual needed, the lower his/her level of self-efficacy (Coffman, 2008). Over-all, results support that improving self-efficacy in this population may lead to longer life expectancy and improved QOL (Coffman, 2008).

    Conclusion

    Health care providers and policymakers are positioned to ensure that older adults with diabetes have an optimal chance of achieving a good QOL. Information gained from the current study may be instrumental in developing strategies to increase diabetes self-efficacy, social support, and overall QOL among older adults. Future studies should consider health care provider knowledge of the self-efficacy concept when providing education to older adults with diabetes and whether improvements in self-efficacy are associated with better self-management of diabetes. Having this information would assist health care providers in engaging policy-makers to develop policies that help empower older adults living with diabetes to successfully manage this chronic condition and reduce complications.

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    Descriptive Statistics (N = 187)

    Measure Mean (SD) Sample Range n (%)
    Age (years) 74.61 (5.99) 66 to 91
    Female 98 (52.41)
    Education (years) 13.68 (2.64) 2 to 20
    African American 91 (48.66)
    Social support
      Amount 3.54 (1.57) 1 to 5
      Satisfaction 4.41 (0.93) 1 to 5
    Self-efficacy 31.75 (4.87) 17 to 40
    Quality of life 12.93 (1.70) 8 to 15

    Correlation Matrix of Study Variables

    Variable r (p Value)
    Age Female Education African American Amount of Support Satisfaction With Support Self-Efficacy QOL
    Age 1
    Female 0.175 (0.0165) 1
    Education 0.086 (0.2425) −0.122 (0.0959) 1
    African American −0.127 (0.0835) 0.2209 (0.0024) −0.208 (0.0043) 1
    Amount of support −0.032, (0.6677) −0.034 (0.6476) −0.023 (0.7502) −0.045 (0.8422) 1
    Satisfaction with support −0.076 (0.3018) −0.027 (0.7107) 0.06 (0.4149) −0.075 (0.3076) 0.371 (<0.0001) 1
    Self–efficacy 0.095 (0.1961) −0.207 (0.0044) 0.206 (0.0047) −0.147 (0.0449) 0.053 (0.4691) 0.413 (<0.0001) 1
    QOL −0.032 (0.6669) −0.147 (0.0452) 0.187 (0.0105) −0.112 (0.1281) −0.018 (0.8061) 0.23 (0.0053) 0.416 (<0.0001) 1

    Covariate-Adjusted Relationships Between Variables of Interest and Quality of Life

    Measure Standardized Beta (B) Unstandardized Beta (b) Standard Error t Statistic p Value
    Intercept 0 9.239 1.713 5.39 <0.0001
    Age −0.072 −0.02 0.02 −1.02 0.3088
    Female −0.035 −0.119 0.245 −0.49 0.6267
    Education 0.102 0.066 0.045 1.46 0.1453
    African American −0.034 −0.115 0.24 −0.48 0.6317
    Satisfaction with social support 0.033 0.06 0.137 0.44 0.663
    Self-efficacy 0.376 0.131 0.027 4.85 <0.0001

    Keypoints

    Bowen, P.G., Clay, O.J., Lee, L.T., Vice, J., Ovalle, F. & Crowe, M. (2015). Associations of Social Support and Self-Efficacy With Quality of Life in Older Adults With Diabetes. Journal of Gerontological Nursing, 41(12), 21–29.

    1. Higher levels of satisfaction with diabetes-related social support are associated with better quality of life.

    2. Better social support may positively influence disease management burden and quality of life.

    3. Higher levels of diabetes self-efficacy are associated with better quality of life.

    4. Strategies designed to improve diabetes self-efficacy may be beneficial for improving quality of life among older adults.

    Authors

    Dr. Bowen is Assistant Professor, and Dr. Lee is Assistant Professor, School of Nursing; Dr. Clay is Associate Professor, and Dr. Crowe is Associate Professor, Department of Psychology; Mr. Vice is Student Assistant, School of Health Professions; and Dr. Ovalle is Professor, Department of Medicine, Division of Endocrinology, Diabetes & Metabolism, University of Alabama–Birmingham, Birmingham, Alabama.

    The authors have disclosed no potential conflicts of interest, financial or otherwise. This work was supported in part by the National Institute on Aging (NIA) (grant P30AG022838) (UAB Roybal Center) and National Center for Advancing Translational Sciences (NCATS) (award number UL1TR00165) (UAB Center for Clinical and Translational Science). The content is solely the responsibility of the authors and does not necessarily represent the official views of NIA, NCATS, or the National Institutes of Health.

    Address correspondence to Pamela G. Bowen, PhD, FNP-BC, Assistant Professor, School of Nursing, University of Alabama–Birmingham, NB 416, 1720 2nd Avenue South, Birmingham, AL 35294-1210; e-mail: pbowen@uab.edu.

    Received: September 23, 2014
    Accepted: September 03, 2015
    Posted Online: October 15, 2015

    10.3928/00989134-20151008-44

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